(Date)

Your Name
Your street address
Your city, state, and zip

Agency’s name.
Agency’s street address
Agency’s city, state, and zip

Certified Mail Receipt No.:

Creditor:
Account Number:

Dear_________________,
I am writing in response to your letter dated __________________, (copy enclosed) because I do
not believe I owe what you say I owe.
This is the first I've heard from you, or any other company on this matter therefore, in accordance
with the Fair Debt Collection Practices Act, Section 809(b): Validating Debts I respectfully request
that you provide me with the following information:
* (1) the amount of the debt;
* (2) the name of the creditor to whom the debt is owed;
* (3) Provide a verification or copy of any judgement (if applicable);
* (4) Proof that you are licensed to collect debts in (insert name of your state)
Be advised that I am fully aware of my rights under the Fair Debt Collection Practices Act and the
Fair Credit Reporting Act. Also be advised that I am keeping very accurate records of all
correspondence from you and your company.
I have disputed this debt; therefore, until validated you know your information concerning this debt
is inaccurate. Thus, if you have already reported this debt to any credit-reporting agency (CRA) or
Credit Bureau (CB) then, you must immediately inform them of my dispute with this debt.
Reporting information that you know to be inaccurate or failing to report information correctly
violates the Fair Credit Reporting Act § 1681s-2. Should you pursue a judgement without validating
this debt, I will inform the judge and request the case be dismissed based on your failure to comply
with the FDCPA.
Finally, if you do not own this debt, I demand that you immediately send a copy of this dispute
letter to the original creditor so they are also aware of my dispute with this debt.

Your name